The Group Health’s Claim: The Outpatient
It is undeniable that group health insurance premiums increase yearly. The HR department with the BOD should work hand in hand, and gather information about the increase. The search can begin with the total claims and the trends of claim.
Outpatient claims are said to have contributed large amount of claim, while inpatient claims are relatively acceptable. The latter can feature a shocking claim occurrences due to pro-longed hospitalization of an insured member-critical illness, or severe injury of an accident.
Maternity claims are considerably moderate since most of insurance companies are not very keen on offering this cover, the cost would not be effective and likewise, the insurer or the BODs have to pay quite high extra premiums.
As for Dental claims, the amount of claims shows a good record from the insurance company’s point of view. Claims can be around scaling, amalgam-filled treatment. Other big amount requires dental surgery, and its frequency of claims can be anticipated.
Of the four, outpatient claims take up so much port folio of the annual claim report. Those claims of infants and children outpatient claims are among of them. Therefore, some companies reinforce a very strict rule of the game on the outpatient cover such as giving limitation or aggregate claims per annum, or no drugs are claimable without prescription, and many others.
If this persists, some insurance companies will not insure outpatient, instead they resolve with self insurance conducted by the employers. So, the overall claim can be reduced, perhaps the employers can negotiate to get rebate on the total premiums in the next renewal date.
